Age Affects SUI Surgery Outcomes
“As the number of older women seeking care for this debilitating condition continues to increase, it is imperative that we be able to adequately counsel them with respect to their risks and benefits with surgery, especially about the potential for continued symptoms and the need for subsequent treatment,” said Holly Richter, PhD, MD, professor and director of the urogynecology division at the University of Alabama at Birmingham.
She and her colleagues with the Urinary Incontinence Treatment Network compared peri- and postoperative outcomes for up to two years in younger (less than 65 years of age) and older (aged 65 years or more) women undergoing Burch colposuspension or pubovaginal sling placement for the treatment of SUI.
“Despite a pressing need for data on surgical outcomes in older women, there has been a relative paucity of such information in the literature,” Dr. Richter pointed out. “The lack of information may be due to the fact that older patients are frequently excluded from clinical trials.”
Overall, 655 women were included in the analysis of perioperative events and 554 women in the analysis of two-year outcomes. Eighty-one women were 65 years of age or older, and 574 women were younger than 65 years.
The data showed that older women took slightly longer to resume normal activities (50 vs. 42 days). The time to normal voiding was about the same in the two groups (14 vs. 11 days). Older women were nearly four times as likely to have a positive stress test at two-year follow-up, according to the investigators.
They also had less subjective improvement in SUI as evidenced on the widely validated Medical, Epidemiological and Social Aspects of Aging questionnaire. At two-year follow-up, scores in all patients were lower, but compared with younger patients, scores of older patients declined 8 points more for SUI and 7 points more for urge incontinence.
The investigators observed no differences in the frequency or type of perioperative adverse events and length of hospital stay in the two study groups.
“Our findings suggest that women over 65 years of age who are contemplating surgery for stress urinary incontinence, with or without concomitant prolapse surgery, can expect to do as well as younger women with respect to their surgical experience, voiding function, and patient satisfaction, but older women may have lower subjective and objective cure rates,” Dr. Richter noted.
She emphasized that further research is needed to determine if the findings will be similar with the newer midurethral sling procedures.